Quality statement 5: Risk assessment – smoking cessation

Quality statement

Pregnant women who smoke are referred to an evidence-based stop smoking service at the booking appointment.

Quality measure

Structure

a) Evidence of local arrangements that pregnant women have their smoking status recorded at the booking appointment.

b) Evidence of local arrangements to ensure that pregnant women who smoke are referred to an evidence-based stop smoking service.

c) Evidence of local arrangements to ensure that pregnant women who smoke and decide not to attend an evidence-based stop smoking service receive follow-up.

Data source: a) Local data collection through Maternity Services Secondary Uses Dataset b) local data collection through PHQ30 and c) local data collection.

Process

a) Proportion of pregnant women accessing antenatal care whose smoking status is recorded at the booking appointment.

Numerator – the number of women in the denominator whose smoking status is recorded at the booking appointment.

Denominator – the number of pregnant women accessing antenatal care.

b) Proportion of pregnant women who smoke who are offered a referral to an evidence-based stop smoking service.

Numerator – the number of women in the denominator who are offered a referral to an evidence-based stop smoking service.

Denominator – the number of pregnant women accessing antenatal care who smoke.

c) Proportion of pregnant women who smoke who are referred to an evidence-based stop smoking service.

Numerator – the number of women in the denominator who are referred to an evidence-based stop smoking service.

Denominator – the number of pregnant women accessing antenatal care who smoke.

d) Proportion of pregnant women who smoke and decide not to attend an evidence-based stop smoking service who receive follow-up.

Numerator – the number of women in the denominator who decide not to attend an evidence-based stop smoking service who receive follow-up.

Denominator – the number of pregnant women who smoke and decide not to attend an evidence-based stop smoking service.

Data source: a) Local data collection. The Maternity Services Secondary Uses Dataset, once implemented, will collect data on 'the mother's self-reported smoking status at the Booking Appointment' (global number 17201020). b), c) and d) Local data collection.

Outcome

a) Quit rates for pregnant women.

b) Smoking rates in pregnancy.

Data source: a) Local data collection.

b) The Smoking at Time of Delivery (SATOD) collection covers information on the number of women smoking and not smoking at time of delivery (childbirth). Each PCT (and a number of care trusts) is required to submit three figures each quarter:

  • total number of maternities

  • number of women known to smoke at the time of delivery

  • number of women known not to smoke at the time of delivery.

From 2011–12 quarter 3 onwards, the Information Centre for Health and Social Care has taken over responsibility for publishing 'Statistics on women's smoking status at time of delivery: England' from the Department of Health. The reports from 2011–12 quarter 3 are available from the Information Centre for Health and Social Care.

The Maternity Services Secondary Uses Dataset, once implemented, will collect data on 'the mother's self-reported smoking status, specifically after the birth of the baby' (global number 17207150).

PHQ30: Smoking quitters – Number of users of NHS stop smoking services who report that they are not smoking 4 weeks after setting a quit date. Data are broken down into sub-categories, which include 'Pregnant women setting a quit date and outcome'. Monitoring frequency: quarterly.

What the quality statement means for each audience

Service providers ensure that systems are in place to ensure that all pregnant women who smoke are referred to an evidence-based stop smoking service at their booking appointment.

Healthcare professionals refer all pregnant women who smoke to an evidence-based stop smoking service at their booking appointment.

Commissioners ensure they commission services which refer all pregnant women who smoke to an evidence-based stop smoking service at their booking appointment.

Pregnant women who smoke are referred to an evidence-based stop smoking service at their booking appointment.

Source guidance

Definitions

Advice on smoking cessation should be first provided at the booking appointment and when appropriate throughout the period of antenatal care. The midwife may provide the pregnant woman with information (in a variety of formats, for example a leaflet) about the risks to the unborn child of smoking when pregnant and the hazards of exposure to secondhand smoke for both mother and baby.

Women who smoke or have recently quit smoking should be referred to an evidence-based stop smoking service if:

  • they say they smoke, or

  • they have a carbon monoxide (CO) reading of 7 ppm or above, or

  • they say they have quit smoking in the past 2 weeks, or

  • they say they are a light or infrequent smoker but register a low CO reading (for example, 3 ppm).

[adapted from Quitting smoking in pregnancy and following childbirth (NICE guideline PH26)]

Evidence-based stop smoking services are local services providing accessible, evidence-based and cost-effective support to people who want to stop smoking. The professionals involved may include midwives who have been specially trained to help pregnant women who smoke to quit (NICE pathways: Evidence-based stop smoking services and quitlines).

At the time of referral the pregnant woman should be given the number of an evidence-based stop smoking service. This may include the number of the NHS Pregnancy Smoking Helpline (0800 1699 169), details of their website and a number for a local helpline if one is available.